AB0288 ECHOCARDIOGRAPHIC FINDINGS BY SPECKLE TRACKING IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: C. A. Rosal Arteaga, S. Cerpa-Cruz, E. Purón González, G. Martinez-Bonilla, V. Gonzalez-Diaz, J. Hernandez-del Rio, M. E. Ventura Valenzuela, S. Contreras Sánchez
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is a chronic systemic inflammatory joint disease characterized by infiltration of the synovial membrane by B cells, T cells, and monocytes. Among the most important extra-articular manifestations are those of the cardiovascular system. Cardiovascular involvement in this group of patients is highly relevant as it is an important cause of morbidity and mortality (1,2). Subclinical involvement is underestimated and currently, conventional cardiovascular risk stratification methods are insufficient to detect early stages of cardiovascular disease. Speckle tracking has emerged as a tool to measure early myocardial dysfunction and has been shown to be useful as a predictor of cardiovascular events. Normal reference values ​​have recently been published (3). Objectives To describe the echocardiographic findings by speckle tracking (ST) of the left atrium (LA) and left ventricle (LV) in patients with RA without prior known cardiovascular disease and to compare it with healthy controls. To establish if there is an association of echocardiographic findings with characteristics of the disease. Methods Thirty-four patients with RA without a history of previous cardiovascular disease and 50 healthy controls were included. Echocardiographic measurements were made by Speckle Tracking of the LA in its 3 phases and of the LV expressed as Global Longitudinal Strain (GLS), in addition to conventional measurements. Quantitative variables were expressed as proportions, continuous data were reported as means and standard deviations. Both groups were compared with t-student test and a linear regression model was used to evaluate age and RA presence in relation to the abnormality or normality of Speckle tracking findings. SPSS was used for statistical analysis. Results A significant difference was found in LA global longitudinal strain compared to controls (45.14% vs 57.34%, p=0.020), LA conduit strain (25.69% vs 36.74%, p=0.002) and LV global longitudinal strain (- 17.6% vs. -22.62%, p=0.000). There was no significant difference in LA contractile strain and LA strain rate. In the echocardiographic measurements by conventional technique, no differences were found in the measurement of the LV ejection fraction or LA volume index, but LA ejection fraction was lower in the RA group (53.8% vs 78.2%, p=0.000). Rheumatoid arthritis was associated with LA speckle tracking abnormality in the reservoir, conduit, and LV global longitudinal phases. Conclusion The patients with rheumatoid arthritis presented subclinical echocardiographic alterations of myocardial deformation measured by speckle tracking both in the left ventricle (assessed as GLS) and in the left atrium, these were associated with RA regardless of age. References [1]Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al. Rheumatoid arthritis. Nat Rev Dis Primer. 2018 Jun;4(1):18001. [2]Humphreys JH, Warner A, Chipping J, Marshall T, Lunt M, Symmons DPM, et al. Mortality Trends in Patients With Early Rheumatoid Arthritis Over 20 Years: Results From the Norfolk Arthritis Register: Trends of Mortality Rates in UK Patients With Early RA. Arthritis Care Res. 2014 Sep;66(9):1296–301. [3]Pathan F, D’Elia N, Nolan MT, Marwick TH, Negishi K. Normal Ranges of Left Atrial Strain by Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr. 2017 Jan;30(1):59-70.e8. Disclosure of Interests None declared